Thursday, March 24, 2016

Becoming an Ironman for Myself and My Patients

The
sliver of light coming under the door of the windowless office seemed
unbearably bright and offensive. I turned away from it and closed my
eyes. There is a flat spot on the back of my head that, if angled just
right, would lie on the textbook I was using as a pillow. In a few
moments, I would be asleep again. I was supposed to be out seeing
patients, but it was all I could do to show up at work and hide in my
office. My supervisor was a gentle woman who would come check on me a
couple of times a day. She would crack the door and ask, “Dr. Franklin,
why don’t you come out and see one of the new patients?”

“I can’t. I just can’t... I’m no good to anyone.”

Drifting
in and out of consciousness in that dark room seemed far superior to
being up and about, feeling the pain that seemed to emanate from my
chest and flow throughout my body. It was as if my blood had been
replaced by some impossibly dense material that could barely flow,
making every step I took an effort. If I didn’t lie on that floor and
feel my body supported all the way from that flat part of my skull to
the small of my back, to the backs of my ankles, it felt like I might
fall through to the center of the earth, through the dirt, rock, and
then to the molten core where I would be incinerated. I wondered if that
might be better than living like this.

Fearing Stigma but Seeking Help

I
was a psychiatric intern at the time, and I was depressed. But I
couldn’t bring myself to seek treatment. I suffered like that for months
until I saw a colleague in consultation, where I described suffering
the symptoms of attention deficit disorder, but suggested that a
third-line medication for that diagnosis, also used for depression,
might help me. I needed so much more than that medication, but my
depression, my own inhibitions, and stigma kept me from getting the help
I needed. Difficulty concentrating seemed a safer problem to admit to
than depression. I was worried that I wouldn’t be taken seriously as a psychiatrist if it became known that I, too, was a patient.

I
continued to suffer off and on for years, finally getting into real
treatment for the first time after my training was over. A combination
of psychotherapy and medications led to the relief of stabilization.
Ultimately, psychoanalysis, a more intensive therapy experience, helped
me to fundamentally change how I thought about myself and the world,
which led to not just relief, but a transformation of how my mind
worked. Eventually, I was able to stop taking medicines. The way I had
felt only years before seemed so far away. I felt a part of the human
race.

Until
now, I have kept quiet about my experience. A continued fear of stigma
has kept me quiet. I felt that if I was known as a psychiatric patient,
even a so-called “cured” one, I would be labeled or disgraced or
stereotyped. I thought it might hold back my career.

But the only way to combat stigma is to speak out. This
is not easy, but I am inspired by those that have travelled before me
on this road and by my current patients. I can’t go on urging them to be
courageous, to face down the stigma they were feeling, without doing
all I can to fight stigma myself. Only by shining the light of
truth on people’s lived experience of mental illness will stigma finally
become a thing of the past.

Why a Triathlon?

After
my psychoanalysis was over, I took up triathlons. Exercise has not only
helped my mood, but I found that endurance sports are a powerful
metaphor for what living with a mental illness can be like. In some
ways, training for and finishing races makes me feel that I have mastery
over that part of me that suffered so much.

In triathlons, like in depression, you have to go on putting one foot in front of another for as long as it takes. It will be painful. Your best-laid plans will go
awry. Small mistakes early in the race can turn into big problems
before the end of the day. The finish line will seem an impossibly long
way away. There are moments of despair, but also moments of triumph.
There is beauty around the next corner that can give you hope, if you
only look up long enough to take it in. But preparing for and finishing
the race is much more about your mind than your body.

On July 24th,
I will be racing the 140.6 miles of the Ironman Lake Placid triathlon
to fight stigma, to show people that are suffering that treatment works,
and to raise money for the Sheppard Pratt Patient Care Fund so that no one has to go without the treatment they need. 100
percent of the monies donated to this fund are spent on patient care.
Maybe someone we help get treated will become the next courageous voice
in the fight against stigma.Please give generously, whatever that means for you in your life. Thank you for your support.

Friday, March 18, 2016

Yesterday, I was a speaker at the University of Maryland's Cultural Diversity Day.
The theme was Urban Trauma: Understanding Its Impact and Navigating Access to Mental Health Care. I thought I would share some of my slides with our readers. And now I know how to put a PowerPoint Presentation into a blog.

Sunday, March 13, 2016

Perhaps
you could help me. I am a psychiatrist is Baltimore and somehow my
name is on Aetna's provider panel. I never filled out an application or
request with Aetna and I have no desire to be on their panel. Over the
last couple of years, I had gotten a few calls from prospective
patients, clarified that I am not an Aetna provider, at least not
willingly, and left it at that. Recently, the calls have escalated to as
many as 5 a week.

I
have called Aetna repeatedly, and I can't seem to find a voicemail
option that allows me to speak with a human. I received a call (left as
voicemail) from Aetna the other day saying I must refund a patient
because I charged more than the allowable rates for an Aetna-cover patient, and the patient told
them I was not in network, and a number was left for me to call. When I
dialed that number, the automated answer machine knew who I was (I
suppose by my phone number?) but then none of the prompts led to an
option to discuss network participation or to speak with a human. I
have also gone to their website, where there is a place to report
network issues, and I reported there that I am not in network and never
heard anything. I googled the Chief Medical Officer and tried to call
him, without success. This is a lot of time and effort to dis-enroll
from a company I had never enrolled with! Even your contact page is a fiasco.

Network inadequacy is an enormous problem for patients
and Aetna makes it extremely difficult to address.

Wednesday, March 09, 2016

That's a great title for a post, isn't it?Unfortunately, this isn't going to be about anything all that juicy. I'm giving a talk on Access to Care next week to 60 or so psychiatry residents in training. I thought I would ask our readers: What should young psychiatrists know about finding a psychiatrist? Are there things that make it harder or easier to find someone? What should they know about health insurance participation?Write something I hadn't thought of and I'll read it at my presentation!Thank you for your help.